Evidence in the learning organization

Abstract

BackgroundOrganizational leaders in business and medicine have been experiencing a similar dilemma: how to ensure that their organizational members are adopting work innovations in a timely fashion. Organizational leaders in healthcare have attempted to resolve this dilemma by offering specific solutions, such as evidence-based medicine (EBM), but organizations are still not systematically adopting evidence-based practice innovations as rapidly as expected by policy-makers (the knowing-doing gap problem). Some business leaders have adopted a systems-based perspective, called the learning organization (LO), to address a similar dilemma. Three years ago, the Society of General Internal Medicine's Evidence-based Medicine Task Force began an inquiry to integrate the EBM and LO concepts into one model to address the knowing-doing gap problem.MethodsDuring the model development process, the authors searched several databases for relevant LO frameworks and their related concepts by using a broad search strategy. To identify the key LO frameworks and consolidate them into one model, the authors used consensus-based decision-making and a narrative thematic synthesis guided by several qualitative criteria. The authors subjected the model to external, independent review and improved upon its design with this feedback.ResultsThe authors found seven LO frameworks particularly relevant to evidence-based practice innovations in organizations. The authors describe their interpretations of these frameworks for healthcare organizations, the process they used to integrate the LO frameworks with EBM principles, and the resulting Evidence in the Learning Organization (ELO) model. They also provide a health organization scenario to illustrate ELO concepts in application.ConclusionThe authors intend, by sharing the LO frameworks and the ELO model, to help organizations identify their capacities to learn and share knowledge about evidence-based practice innovations. The ELO model will need further validation and improvement through its use in organizational settings and applied health services research.

Using Numbers Creates Value for Health Professionals: A Quantitative Study of Pain Management in Palliative Care

“…Previous research highlights the importance of searching for variety by making use of data that measure and monitor performance in health care processes. The visualization of pain and pain management through measurements could increase employee participation and understanding of improvement work [5,7,[14][15][16]. By highlighting what needs to be improved and how these improvements can be achieved in a planning process, improvement ideas can be tested and visualized on a small scale through the PDSA cycle: Plan, Do, Study, and Act [14].…”

“…The quality of operations is secured by offering staff systematic and continuous training. Hence, health care management and leadership are important influencing factors for patient safety and high-quality care [5,16,[25][26][27][28][29][30]. The staff need an effective learning environment, well-functioning communication, and competent leadership to develop a learning organization that promotes high-quality care [27,31].…”

“…The difference between evidence-based care in theory and practice is known as espoused theory and theory-in-use, i.e., how individuals within an organization act and relate to established procedures and policies [11]. Double-loop learning is a reflective way to learn about the values, standards, and policies of a unit, and is related to espoused theory and theory-in-use [5,[11][12][13].…”

“…Hence, health systems must be economically sustainable, in line with good clinical practice, and developed in consultation with the patient [1][2][3]. Evidence-based care is based on three approaches: patient needs and desires, staff skills and experience, and recent evidence in this research field [4][5][6][7][8]. Clinical research and guidelines can be difficult for the staff to absorb due to lack of time, interest, motivation, knowledge, or inability to change ingrained patterns [4,6,7,9,10].…”

“…Staff's motivation for learning is imperative to continuous improvements in patient care [5,16,[21][22][23][24]. The Model for Understanding Success in Quality, MUSIQ [24], highlights the importance of motivation due to leadership.…”